NASHVILLE — A top state House Democrat charged Friday that Republican Speaker Beth Harwell has relied on financing gimmicks to pay for her bill seeking to impose work requirements on most able-bodied adults enrolled in Tennessee's Medicaid health care program.
"Speaker Harwell could not come up with the cash she needed to fund the work-requirement Medicaid bill, so Speaker Harwell and the House Republicans have now turned to Washington-style smoke and mirrors to conjure up out of nothing a fake fiscal note to pass their bill without paying for it," Democratic Caucus Chairman Mike Stewart of Nashville said.
"We don't just make up fairy tales to get funding," he added.
Harwell and Rep. Dan Howell's bill, scheduled for floor debate Monday, directs the state to ask the federal Centers for Medicare and Medicaid Services to grant a waiver of Medicaid rules to implement "reasonable work and community engagement requirements" on working-age adults without dependent children under 6.
But under a new amendment, the Haslam administration also is directed to seek simultaneous approval from the U.S. Department of Health and Human services to take money from unused money from Families First, the state's federally funded Temporary Assistance to Needy Families (TANF) program, to underwrite the annual costs of the program.
Legislative fiscal analysts' verdict on the original bill was that Tennessee's annual costs, if the bill becomes law, would amount to some $18.7 million. Another $15.3 million would come from the federal government.
But now, the state's Department of Human Services' current annual federal block grant of $190 million for Families First is coming into play. About 61 percent of the money is spent each year, with the rest going into a reserve for economic downturns.
President Donald Trump has proposed cutting the federal TANF program.
In issuing a fiscal note, the General Assembly's Fiscal Review Committee analysis has several caveats.
"It is unknown to what extent the federal government will allow the use of TANF or other federal funds to effectuate the requirements agreed to by TennCare and CMS," the analysis reads.
Noting that "it is assumed that" officials with TennCare, the state's Medicaid program, would negotiate and implement a waiver that meets both CMS and HHS requirements "so that TANF and federal funding will be used to implement the program."
It also says "future state funds necessary to administer the program are unknown and are dependent on the approved waiver."
Seizing on the uses of "unknown" impact on the state in the fiscal note, Stewart said the Tennessee Constitution requires that any law resulting in expenditure of state funds "shall be null and void unless, during the session in which the act receives final passage, an appropriation is made for the estimated first year's funding."
It thus requires "that you go get money now, not later, not from some fantasy game magically conjured up," Stewart said.
He charged that Harwell, who is running for the GOP gubernatorial nomination, has "dreamed up a political stunt to get votes in the governor's race."
In this case, the state is asking for two waivers. The Trump administration is open to Medicaid work requirements, having already approved them for at least two states. Whether the administration would be open to the second waiver involving funds frtom TANF, the welfare program, remains unclear.
The bill does say Tennessee's "implementation of the waiver shall be contingent upon the available use of TANF funds or other federal appropriations to meet the requirements of the waiver."
Apparently that was good enough for the Senate General Welfare Committee to bypass the Finance Committee and send the measure on to be scheduled for later floor action.
Harwell's spokeswoman, Kara Owen, dismissed Stewart's arguments, saying "work supports and supportive services are one of the defined categories that TANF funds can be used for."
She noted that TennCare originally estimated that case work and supportive services "would be the largest expense in implementing a work requirement, so it only makes sense to leverage the federal dollars that are already available to us for that purpose."
The bill and the waiver's goal, Owen said, "is to move Tennesseans out of poverty, and education and employment are two of the biggest factors in doing so."
Contact Andy Sher at asher@timesfreepress. com or 615-255-0550. Follow him on Twitter @AndySher1.